MEDICARE: NEUROTECH NORTHWEST, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246ZE0500X	EEG Specialist/Technologist
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
3	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1194193037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROTECH NORTHWEST, LLC

Provider Business Mailing Address
First Line	:	626 W MORELAND BLVD
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53188-2433
Country	:	US
Telephone Number	:	262-754-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 140TH PL NE STE 105
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98007-3943
Country	:	US
Telephone Number	:	425-455-0446
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	LANCE MORGAN
Credential	:
Telephone Number	:	262-754-0898

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	07/21/2022

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